Treatment of breast cancer (BC) is a complex multidisciplinary problem. Often, radiation therapy is an obligatory component of treatment of breast cancer patients. Numerous large randomized trials have proved the efficacy of adjuvant radiotherapy in both the standard fractionation regimen in a single focal dose of 2 Gy to a total focal dose of 50 Gy for 25 fractions and in modes of hypofractionation using radiation exposure at a larger daily dose with a reduction in the total treatment time. The presented review summarizes the data of the largest studies on the modes of hypofractionation of postoperative radiotherapy for breast cancer. Most of the studies comparing the standard mode of fractionation of postoperative radiotherapy with the modes of hypofractionation showed comparable results for the main oncological parameters with similar tolerability, frequency of complications and good cosmetic results. It also shows the economic feasibility of applying accelerated regimes in everyday practice. Despite the fact that radiotherapy in the mode of hypofractionation has already become the standard of treatment and is recommended for use by the largest European and American cancer associations, indications for its conduct, the criteria for selection in the studies and the range of recommended single focal doses differ. The obtained results do not give an opportunity to confidently judge the advantage of one or another regime. It is necessary to determine the factors of a favorable and unfavorable prognosis, to clarify the indications for the use of various radiotherapy techniques. Therefore, questions about the optimal mode of hypo-fractionation of adjuvant radiotherapy, the timing of its initiation and the criteria for selecting patients for this type of therapy as part of the comprehensive treatment of breast cancer have not yet been fully resolved. Also open is the choice of optimal single and total doses of radiation, its combination with drug therapy.

Breast cancer remains the most common malignant neoplasm in women. According to the current standards, radiation therapy is one of the most important components of the multi-disciplinary treatment. The efficacy of the postoperative radiotherapy in both the traditional fractionation regimen and in the hypofractionation mode is not questioned. Contrary to the conventional fractionation, hypofractionation implies an increase in the daily dose and a reduction in the total treatment time. This approach helps reduce the treatment costs in patients with breast cancer while maintaining a high treatment efficacy and quality of life.The aim of the study was to analyze the economic efficiency of the dose hypofractionation as compared to the traditional mode of dose fractionation during postoperative radiation therapy in patients with breast cancer.Materials and methods. The study included 220 patients with breast cancer who received a combined treatment. Of these, 120 patients (study group) received hypofractionated radiotherapy (40.5 Gy in 15 fractions) whereas 100 patients of the control group were treated by the conventional therapy of 50 Gy in 25 fractions. Patients of the both groups were comparable by stages of the disease, systemic treatment, age and molecular type of tumor. The cost of treatment was calculated from the price list of this research center.Results. The present economic analysis showed that the method of hypofractionation was more (30% on average) cost-efficient than the conventional regimen while both modalities produced similar rates of total and relapse-free survival. We were then able to identify the main items in the list of medical services that contributed to the estimated difference in the treatment costs. Reducing the number of examinations and the treatment duration help reduce the expenditure of this medical organization.Сonclusion. Hypofractionation of postoperative radiotherapy in patients with breast cancer allows one to reduce the treatment costs as compared to the conventional fractionation regimen. The funds saved by optimizing the costs of postoperative radiation can be directed to the development of additional means of cancer treatment.

48Рак легкого продолжает занимать лидирующее место по показателю смертности среди онкологических заболе-ваний в России и в мире [1,2]. Несмотря на совершен-ствование диагностических процедур и проведение про-филактических мероприятий, большинство случаев рака легкого диагностируют на распространенных стадиях. Для улучшения непосредственных и отдаленных результатов ведется поиск новых методов лечения и их комбинаций. В последнее десятилетие наиболее быстро развивающим-ся направлением является молекулярно-направленная или таргетная терапия. Лекарственные препараты этой группы у больных немелкоклеточным раком легкого (НМРЛ) с драйверными мутациями селективно блоки-руют патологические процессы в опухолевых клетках, что позволяет увеличивать эффективность проводимого лечения и повышать общую выживаемость больных [3]. Ингибиторы тирозинкиназы EGFR показали высокую эффективность в клинических исследованиях и повсед-невной практике, при этом став важным компонентом лечения больных диссеменированным раком легкого. В настоящее время данные литературы и собственный опыт позволяют предполагать грядущее расширение по-казаний к применению препаратов этой группы у боль-ных НМРЛ.EGFR -трансмембранный рецептор, который свя-зывается с эпидермальным фактором роста, его актива-ция приводит к запуску патологических взаимодействий в опухолевой клетке, вызывая пролиферацию, ангиогенез и метастазирование, поэтому данный сигнальный путь является одним из наиболее привлекательных для поис-ка лекарственных воздействий [4]. Первыми таргетными препаратами для лечения НМРЛ стали ингибиторы ти-розинкиназы EGFR. Изначально, клинические испыта- Обобщены сведения о применении таргетной терапии ингибиторами EGFR в неоадъювантном и адъювантном режимах при лечении немелкоклеточного рака легкого (НМРЛ). Проанализированы данные литературы и приведено собственное наблюдение с результатами лечения больного НМРЛ с мутацией гена EGFR в 21-м экзоне типа L858R, которому в качестве компонента комплексного лечения была проведена неоадъювантная терапия гефитинибом. Показано преимущество тар-гетной терапии перед цитостатиками в качестве неоадъюванта при раке легкого. Вопрос об использовании ингибиторов тирозинкиназы EGFR в адъювантном режиме при их предшествующем использовании до операции остается спорным. Применение таргетных препаратов у больных НМРЛ с EGFR-мутацией при местно-распространенной опухоли может стать альтернативой химиотерапии и должно быть изучено в крупномасштабных исследованиях. The paper summarizes information on targeted therapy with epidermal growth factor (EGFR) inhibitors used in neoadjuvant and adjuvant regimens for the treatment of non-small-cell lung cancer (NSCLC). It analyzes the data available in the literature and describes the authors' clinical case and the results of treating the NSCLC patient with EGFR exon 21 L858R mutation who received neoadjuvant treatment with gefitinib as a component of combination therapy. Targeted therapy is shown to have an advantage over cytostatics as a neoadjuvant in lung cancer. Whether EGFR tyrosin...

Currently, lung cancer is a global problem and public health issue in the world. Chemoradiotherapy remains the optimal method in the treatment of patients with unresectable non-small cell lung cancer (NSCLC). Nowadays, immune response checkpoint inhibitors (monoclonal antibodies) are actively introduced into clinical practice which demonstrated significant improvements in the overall survival for patients with unresectable NSCLC. These drugs block programmed cell death protein (PD‑1) and programmed cell death ligand 1 (PD-L1) that increases regulation on the surface of T-cells and improves the patient's immune system respond to tumor cells. In 2019, durvalumab was introduced into clinical practice for the treatment of patients with unresectable NSCLC (stage III) after chemoradiotherapy. In our study, we’ve summarizes studies investigated the feasibility and safety of radiotherapy with immunotherapy for locally advanced lung cancer.

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